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l Zidovudine (ZDV) short course 7 страница
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Oxytocin
Description: Oxytocin, a nonapeptide hormone secreted by the neurons of the supraoptic and paraventricular nuclei of the hypothalamus and stored in the posterior pituitary gland (neurohypophysis) in mammals, indirectly stimulates contraction of uterine smooth muscle.
Indications: IV infusion of dilute solutions of oxytocin is the method of choice for inducing labor at term and stimulating uterine contractions during the first and second stages of labor. It may be used also for inducing of uterine contractility in postpartum period.
Dosage and Administration: Oxytocin is administered IV, rarely IM. For IV infusion 5 units of Oxytocin (1 ml) should be diluted in 400 ml of isotonic solution and entered IV droppingly. The rate of infusion shouldn’t be more than 40 drops per minute.
Side Effects: hypertension, sinus bradycardia, tachycardia, premature ventricular complexes and other arrhythmias, permanent CNS or brain damage, and death secondary to asphyxia (in case of overdose).
Precautions and Contraindications: Oxytocin is contraindicated in patients with a history of hypersensitivity to the drug. Parenteral oxytocin should be used only by qualified professional personnel in a hospital where intensive care and surgical facilities are immediately available.
Mammophysin
Description: Mammophysin – a combined drug containing pituitrin and extract of mammary gland of milch cow. Pharmacologic action: rhythmic contraction of the uterus.
Indications: It is used in cases of utertine hypotony in the early puerperal period for prophylaxis of bleedings.
Dosage: Common packaged dosage form: 3 units in 1 ml in 1-ml ampules. Usual individual dose: 0. 3–1 ml intramuscularly 1-2 times a day.
Replacement Preparations
Calcium Salts
Description: Calcium salts are used as a source of calcium, an essential nutrient cation.
Indications: Calcium salts are used as a source of calcium cation for treatment or prevention of calcium depletion in patients in whom dietary measures are inadequate. Conditions that may be associated with calcium deficiency include hypoparathyroidism, chronic diarrhea, vitamin D deficiency, steatorrhea, sprue, pregnancy and lactation, menopause, pancreatitis, renal failure, alkalosis, and hyperphosphatemia.
Dosage and Administration: The carbonate, citrate, gluconate, lactate, and phosphate salts of calcium are administered orally. Calcium chloride, calcium gluconate may be administered IV. Calcium gluconate is usually administered IV as a 10% solution, calcium chloride as a 2-10% solution, and the gluceptate as a 22% solution. The usual initial IV dose of calcium for emergency elevation of serum calcium is 7-14 mEq for adults. It has been recommended that these doses be repeated every 1-3 days depending on the patient's response. For the treatment of hypocalcemic tetany, 4. 5-16 mEq doses of calcium may be administered IV to adults until therapeutic response occurs. For PO use 1 or 1. 2 g daily in adult patients are recommended.
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Side Effects: Calcium salts are irritating to tissue when administered by IM or subcutaneous injection and cause mild to severe local reactions including burning, necrosis and sloughing of tissue, cellulitis, and soft tissue calcification; venous irritation may occur with IV administration. When injected IV, calcium salts should be administered slowly through a small needle into a large vein to avoid too rapid increase in serum calcium and extravasation of calcium solution into the surrounding tissue with resultant necrosis. Patients may complain of tingling sensations, a sense of oppression or heat waves, and a calcium or chalky taste following IV administration of calcium salts. Rapid IV injection of calcium salts may cause vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest.
Precautions and Contraindications: Calcium salts are contraindicated in patients with ventricular fibrillation or hypercalcemia. IV administration of calcium is contraindicated when serum calcium concentrations are above normal.
Sodium Chloride
Description: Sodium chloride is used as a source of sodium and chloride ions, which are essential ions.
Indications: Sodium chloride injections are used as a source of sodium chloride and water for hydration. Sodium chloride is used in the prevention or treatment of deficiencies of sodium and chloride ions and in the prevention of muscle cramps and heat prostration resulting from excessive perspiration during exposure to high temperature. Sodium chloride is also used to treat deficiencies of sodium and chloride caused by excessive diuresis or excessive salt restriction.
Injection of 0. 9% sodium chloride is used for extracellular fluid replacement and in the management of metabolic alkalosis in the presence of fluid loss and mild sodium depletion. Injection of 0. 9% sodium chloride (normal saline) is also used as a priming fluid for hemodialysis procedures and to initiate and terminate blood transfusions.
Hypertonic (i. e., 3%, 5%) sodium chloride injection is used in the management of severe sodium chloride depletion when rapid electrolyte restoration is essential.
Dosage and Administration: Sodium chloride may be administered orally or by IV infusion.
Dosage of sodium chloride depends on age, weight, clinical condition, and fluid, electrolyte, and acid-base balance of the patient. The usual adult sodium and chloride requirements can be adequately fulfilled by IV infusion of 1 l of 0. 9% sodium chloride injection daily. The usual initial IV dose of 3 or 5% sodium chloride injection is 100 ml given over a 1-hour period. IV infusion of 3 or 5% sodium chloride injection should not exceed 100 ml/hour. The usual oral replacement dosage of sodium chloride is 1-2 g 3 times daily.
Reactions that may occur because of the solution (e. g., from contamination) or administration technique include fever, infection at the site of injection, venous thrombosis or phlebitis extending from the site of injection, and extravasation. Hypervolemia or symptoms resulting from an excess or deficit of one or more ions present in the solution may also occur. Excessive administration of sodium chloride may result in hypernatremia and large amount of chloride may cause a loss of bicarbonate with an acidifying effect. If an adverse effect occurs during administration of sodium chloride injection, the infusion should be discontinued, the patient evaluated, appropriate therapeutic measures instituted if necessary, and the remainder of the fluid saved for examination if necessary.
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Precautions and Contraindications: Changes in fluid balance, electrolyte concentrations, and acid-base balance should be evaluated clinically and via periodic laboratory determinations during prolonged therapy with sodium chloride and in patients whose condition warrants such evaluation.
Intravenous administration of sodium chloride may cause fluid and/or solute overload resulting in dilution of serum electrolytes, overhydration, congestive conditions, or pulmonary edema.
Sodium chloride is contraindicated in patients with conditions in which administration of sodium and chloride is detrimental. Sodium chloride 3 and 5% injections are also contraindicated in the presence of increased, normal, or only slightly decreased serum electrolyte concentrations.
Hetastarch
Description: Hetastarch, a nonprotein colloid, is a plasma volume expander.
Indications: Hetastarch is used for early fluid replacement and for plasma volume expansion in the adjunctive treatment of certain types of shock or impending shock when whole blood or blood products are not available or when the need for haste precludes the necessary cross-matching of blood products. Types of shock for which hetastarch may be used include those resulting from burns, hemorrhage, surgery, sepsis, or other trauma in which a circulating volume deficit is present. Hetastarch is not a substitute for whole blood or plasma and has no oxygen-carrying capacity. Hetastarch appears to be comparable with albumin as a plasma volume expander.
Dosage and Administration: Hetastarch is administered by IV infusion.
When hetastarch is used as an adjunct for the treatment of shock, dosage and the rate of infusion depend on the amount of fluid loss and the resultant hemoconcentration and must be determined by the requirements of the patient. The usual adult dose of hetastarch 6% solution is 30-60 g (500-1000 ml). Total daily dosage of a 6% solution usually should not exceed 1. 2 g/kg (20 ml/kg) or 90 g (1500 ml). In patients with acute hemorrhagic shock, hetastarch solution may be administered at a rate approaching 1. 2 g/kg per hour (20 ml/kg per hour); slower rates of administration are generally used in patients with burns or septic shock.
Side Effects: Hetastarch appears to have little or no antigenic properties; however, allergic or sensitivity reactions have been reported. Vomiting, slight temperature elevations, chills, itching, submaxillary and parotid gland enlargement, mild influenza-like symptoms, headache, myalgia, peripheral edema of the lower extremities, and anaphylactoid reactions manifested as periorbital edema, urticaria, and wheezing have occurred in patients receiving the drug.
Precautions and Contraindications: Because hetastarch may interfere with platelet function, the drug should be used with caution in patients with thrombocytopenia. Since large volumes of hetastarch solution may cause hemodilution, the patient's hematocrit should be determined after administration of the drug and care should be taken to avoid depressing it below 30% by volume. The possibility of circulatory overload should be considered in patients receiving hetastarch. Reproduction studies in mice receiving hetastarch have not revealed evidence of harm to the fetus. However, the drug should not be used in pregnant women, especially during early pregnancy, unless the potential benefits to the mother outweigh the potential risks to the fetus.
Sedative Drugs
Magnesium Sulfate
Description: Magnesium sulfate is a sedative agent. Parenteral magnesium sulfate exhibits anticonvulsant properties.
Indications: Magnesium sulfate is generally considered the drug of choice for the prevention and control of seizures in severe preeclampsia or in eclampsia. Parenterally administered magnesium sulfate is an important drug in the empirical management of convulsive toxemia of pregnancy. Magnesium sulfate is also used in the management of uterine tetany especially that associated with the use of oxytocic agents. Magnesium sulfate has been used in selected patients to inhibit uterine contractions in preterm labor (tocolysis) and thus prolong gestation when such prolongation of intrauterine life would be expected to benefit pregnancy outcome. It is usually used in acute asthma, acute myocardial infarction. It can be as laxative agent when entered orally.
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Dosage and Administration: In severe preeclampsia or eclampsia, an initial dose of 4 g (16 ml of 25% solution of magnesium sulfate) should be diluted in 34 ml of 0. 9% sodium chloride and entered IV very slowly (during 15 minutes). After the initial IV dose, magnesium sulfate (MS) should be administered in a dose of 1-3 g/hour by constant IV infusion. The solution for constant therapy should be prepared by following scheme: 30 ml of 25% solution of MS + 220 ml of 0. 9% sodium chloride. The resulted 3. 33% solution of MS should be entered IV droppingly with the rate 11-33 drops/min (appropriately 1-3g/hour). Dosage for the next 24 hours should be based on the serum concentration and urinary excretion of magnesium following the initial dose. Subsequent doses should be sufficient to replace the magnesium excreted in the urine and will be approximately 65% of the initial dose administered IM at 6-hour intervals. Therapy should continue until paroxysms cease.
For acute tocolytic therapy in the management of preterm labor, IV magnesium sulfate dosages of 4-6 g infused over 20 minutes as a loading dose, followed by maintenance infusions of 2-4 g per hour for 12-24 hours as tolerated after contractions cease, have been used.
Side Effects: Adverse effects associated with parenteral magnesium sulfate therapy are caused by magnesium intoxication. Signs of hypermagnesemia include flushing, sweating, hypotension, depression of reflexes, flaccid paralysis, hypothermia, circulatory collapse, depression of cardiac function, and CNS depression. These symptoms can proceed to fatal respiratory paralysis. Hypocalcemia with signs of tetany secondary to magnesium sulfate therapy for eclampsia has been reported.
Precautions and Contraindications: Patients receiving parenteral magnesium sulfate should be observed carefully, and serum magnesium concentration should be monitored to avoid overdosage. Disappearance of the patellar reflex is a useful clinical sign to detect the onset of magnesium intoxication. When repeated doses of the drug are given parenterally, knee jerk reflexes should be tested before each dose and if they are absent, no additional magnesium should be given until they return. In addition, the respiration rate should be at least 16 per minute prior to parenteral administration of each dose of magnesium sulfate, and therapy should not be continued unless urine output is 100 ml or more during the 4 hours preceding each dose. In the event of overdosage, artificial ventilation must be provided until a calcium salt can be given IV.
The neonate is usually not compromised by excess magnesium when IM magnesium sulfate is administered to the toxemic mother; however, when magnesium sulfate therapy is administered by continuous IV infusion (especially if for more than 24 hours preceding delivery), the possibility of the neonate showing signs of magnesium toxicity, including neuromuscular or respiratory depression, is increased. Since magnesium is distributed into milk during parenteral magnesium sulfate administration, the drug should be used with caution in nursing women.
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Lorazepam (Ativan)
Description: Benzodiazepine, sedative–hypnotic, anxiolytic, amnestic, anticonvulsant, skeletal muscle relaxant.
Indications: Patients with chronic neuropathic pain exhibiting sleep disturbances, anxiety and restlessness, skeletal muscle spasm.
Dosage: Initial adult daily oral dosage is 2 mg in divided doses of 0. 5 mg, 0. 5 mg, and 1 mg, or of 1 mg and 1 mg. The daily dosage should be carefully increased or decreased by 0. 5 mg depending on tolerance and response.
Side Effects: Drowsiness, dizziness, weakness, fatigue and lethargy, disorientation, ataxia, anterograde amnesia, nausea, change in appetite, change in weight, depression, blurred vision and diplopia, psychomotor agitation, sleep disturbance, vomiting, sexual disturbance, headache, skin rashes, and GI, ear, nose, and throat, musculoskeletal, and respiratory disturbances.
Precautions: Not recommended for use in depressive neurosis or in psychotic reactions; avoid alcohol; caution in patients with limited pulmonary function; hepatic or renal disease; and debilitated patients, and those with organic brain syndrome.
Diazepam (Valium, Seduxen, Relanium): See also anticonvulsant agents.
Droperidol (Inapsine)
Description: Butyrophenone, dopamine antagonist, antipsychotic, antiemetic.
Indications: Nausea, vomiting, and anxiety. In obstetrical practice droperidol is used for management of patients with hyperemesis gravidarum, moderate and severe forms of preeclampsia as neuroleptic agent.
Dosage: 0. 625–2. 5 mg IV every 4–6 hours; higher doses for anxiolysis. In patients with hyperemesis gravidarum, moderate and severe forms of preeclampsia droperidol is used in a dose of 2. 0-4. 0 ml IM/IV.
Side Effects: Shares toxic potential of phenothiazines: dysphoria, hypotension, sedation, and respiratory depression, especially in combination with opioids.
Precautions: Contraindicated in patients with Parkinson's disease and a history of neuroleptic syndrome.
Haloperidol (Haldol)
Description: Butyrophenone, antipsychotic, antiemetic.
Indications: Nervous, mental, and emotional conditions (e. g., agitation, confusion); Tourette's syndrome.
Dosage: 0. 5–5 mg PO 2–3 times daily.
Side Effects: Drowsiness, dizziness, or blurred vision, stomach upset, loss of appetite, headache, drooling, dry mouth, sweating, sleep disturbances or restlessness.
Precautions: Difficulty in urinating, Parkinson's disease, glaucoma, lung disease, heart or blood vessel disease, seizure disorder, or disease of the thyroid, kidney, liver, or prostate.
Thiopental Sodium
Description: Thiopental sodium (Thiopentone) is barbituric–hypnotic, narcotic agent.
Indications: Thiopentone is used for IV narcosis. In obstetrical practice it is recommended to use in patients with eclampsia.
Dosage: For narcosis use 20-30 ml of 2% solution. In patients with eclampsia use 450-500 mg IV within 3-4 minutes.
Contraindications: organic disease of liver and kidneys, diabetes mellitus, severe emaciation, collapse, bronchial asthma.
Appendix 3. Commonly used abbreviations
| ABN | abnormal | Abnormal |
| AC | abdominal circumference | |
| AF | amniotic fluid | |
| AFP | alpha-fetoprotein | |
| APH | antepartum hemorrhage | |
| ARM | artirficial rupture of membranes | |
| ARD | acute respiratory disease | |
| ACTH | adrenocorticotropic hormone | |
| ANC | absolute neutrophil count | |
| APCR | activated protein C resistance | |
| APTT | activated partial thromboplastin time | |
| BACT | bacteria | |
| BBT | basal body temperature | |
| BPD | biparietal diameter | |
| BPP | biophysical profile | |
| BMI | body mass index | |
| BOA | birth out of asepsis, born on arrival | |
| CBC | complete blood count | |
| CDH | congenital diaphragmatic hernia | |
| CMV | cytomegalovirus | |
| CP | cerebral palsy | |
| CRH | corticotropin-releasing hormone | |
| CRL | crown-rump length | |
| C/S | cesarean section | |
| CSF | cerebrospinal fluid | |
| CPD | cephalopelvic disproportion | |
| CT | computerized tomography | |
| CTG | cardiotocography | |
| CVS | chorion villus sampling | |
| DIC | disseminated intravascular coagulation | |
| D & E | dilation and evacuation | |
| DVT | deep vein thrombosis | |
| ECG | electrocardiogram | |
| ECV | external cephalic version | |
| EDD | estimated date of delivery | |
| EEG | electroencephalogram | |
| EFW | estimated fetal weight | |
| ERPC | evacuation of retained products of conception | |
| ESR | erythrocyte sedimentation rate | |
| ET | embryo transfer | |
| FBS | fetal blood sampling | |
| FDIU | fetal death in utero | |
| FEV1 | forced expiratory volume per second | |
| FHS | fetal heart sounds | |
| FL | femur length | |
| FM | fetal movements | |
| FSE | fetal scalp electrode | |
| FTSVD | full-term spontaneous vaginal delivery | |
| G | gravida | |
| GnRH | gonadotropin-releasing hormone | |
| GP | general practitioner | |
| GDM | gestational diabetes mellitus | |
| Hb | haemoglobin | |
| HBsAg | hepatitis B surface antigen | |
| HC | head circumference | |
| hCG | human chorionic gonadotropin | |
| hGH | human growth hormone | |
| Hct | hematocrit | |
| HIE | hypoxic ischaemic encephalopathy | |
| HIV | human immunodeficiency virus | |
| hPL | human placental lactocen | |
| HPV | human papillomavirus | |
| HSV | herpes simplex virus | |
| HVS | high vaginal swab | |
| IDDM | insulin-dependent diabetes mellitus | |
| IOL | induction of labor | |
| IUD | intrauterine death | |
| IUGR | intrauterine growth restriction (retardation) | |
| IUP | intrauterine pregnancy | |
| IVF | in vitro fertilization | |
| IVH | intraventricular hemorrhage | |
| LBW | low birth weight | |
| LFTs | liver function tests | |
| LFAVD | low forceps–assisted vaginal delivery | |
| LGA | large for gestational age | |
| LH | luteinizing hormone | |
| LMP | last menstrual period | |
| LSCS | lower segment cesarean section | |
| L-S | lecithin-sphingomyelin ratio | |
| MC& S | microscopy, culture and sensitivities | |
| MCV | mean corpuscular volume | |
| MFM | maternal fetal medicine | |
| MRI | magnetic resonance imaging | |
| MROP | manual removal of placenta | |
| MSU | midstream specimen of urine | |
| NAD | nothing abnormal detecting | |
| NEC | necrotizing enterocolitis | |
| NEG | negative | |
| NIDDM | non-insulin-dependent diabetes mellitus | |
| NST | nonstress test | |
| NND | neonatal death | |
| NNU | neonatal unit | |
| NTD | neural tube defect | |
| OA | occipito-anterior | |
| OFD | occipito-frontal diameter | |
| OP | occipito-posterior | |
| OT | occipito-transverse | |
| P | para | |
| PCA | patient-controlled anaesthesia | |
| PCR | polymerase chain reaction | |
| PE | pulmonary embolism | |
| PET | pre-eclamptic toxaemia | |
| PIH | pregnancy-induced hypertension | |
| PMR | prenatal mortality rate | |
| Pp | postpartum | |
| PPA | prolonged peridural analgesia | |
| PPH | postpartum hemorrhage | |
| PPIH | proteinuric pregnancy-induced hypertension (pre-eclampsia) | |
| PPROM | preterm prelabour rupture of membranes | |
| POD | postoperative day | |
| POS | positive | |
| RBC | red blood cells | |
| ROM | rupture of membrane | |
| RDS | respiratory distress syndrome | |
| Rh | rhesus | |
| RI | resistance index | |
| SAB | spontaneous abortion | |
| SCBU | special care baby unit | |
| SFH | symphysis-fundal height | |
| SGA | small for gestational age | |
| SG | specific gravity | |
| SLE | systemic lupus erythematosus | |
| SOL | stimulation of labor | |
| SROM | spontaneous rupture of membranes | |
| STOP | suction termination of pregnancy | |
| SVD | spontaneous vaginal delivery | |
| TCD | trans-cerebellar diameter | |
| TOP | termination of pregnancy | |
| TOS | trial of scar | |
| TPHA | treponemal pallidum haemagglutination assay | |
| TRH | thyrotropin-releasing hormone | |
| TTTS | twin-to-twin transfusion syndrome | |
| USS | ultrasound scan | |
| UTIs | urinary tract infections | |
| VDRL | venereal disease research laboratory test | |
| VE | vaginal examination | |
| VHA | virus hepatitis A | |
| VHВ | virus hepatitis B | |
| VHD | virus hepatitis D | |
| VHE | virus hepatitis E | |
| Vtx | vertex | |
| WT | Wassermann test |
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